Table 2.
Selected studies of treatment of recurrent FSGS after kidney transplantation (published after 2010 with more than 10 participants)
| Treatment | Study | Population | Design | Total (n) | Dosage | Response Rate Complete Remission+ Partial Remissiona/No Remission (%) | Comments |
|---|---|---|---|---|---|---|---|
| Plasmapheresis | Ponticelli et al. 2010 (82) | Children and adults | Review of case series and case reports | 144 | Variable | 98 out of 144 (68%) | Review of case reports, therefore publication bias |
| Gonzalez et al. 2011 (78) | Children | Retrospective, single center | 17 | Unknown | 15 out of 17 (88%) | Treatment of recurrent FSGS not described in methods | |
| Schachter et al. 2010 (83) | Children and adults | Retrospective, single center | 12 | PP: 4–48 sessions | 8 out of 12 (75%) | ||
| Mansur et al. 2019 (84) |
Children and adults | Retrospective, single center | 61 | PP: median 20 sessions | 22 out of 61 (36%) | Patients also received high dose steroids (70%) Some patients also received RTX (16%) |
|
| Francis et al. 2018 (85) | Children | Retrospective, multicenter | 20 | PP: 10–92 sessions | 15 out of 20 (75%) | Many other treatments used: iv CsA, CP, RTX, high dose steroids, ABT, galactose | |
| Plasmapheresis + rituximab | Alasfar et al. 2018 (80) | Adults | Prospective single center | 40 | PP: >10 sessions RTX: 1–2 doses (375 mg/m2) | 35 out of 40 (87%) | Not all participants received RTX (50%) No definition of recurrent FSGS |
| Uffing et al. 2020 (5) | Adults | Retrospective, multicenter | 61 | Variable | 35 out of 61 (57%) | Large differences between treatment regimen between patients Not all patients received RTX (57%) |
|
| Garrouste et al. 2017 (86) | Adults | Retrospective, multicenter | 19 | PP: unknown RTX: 1–4 doses (375 mg/m2) |
12 out of 19 (63%) | Some patients also received iv CsA (26%) | |
| Alachkar et al. 2013 (87) | Adults | Retrospective, single center | 24 | PP: median 15 sessions RTX: 1–2 doses (375 mg/m2) |
19 out of 24 (79%) | Not all patients received RTX (54%) | |
| Staeck et al. 2015 (88) | Adults | Retrospective, single center | 12 | PP: median 11 sessions RTX: unknown |
11 out of 12 (92%) | Not all patients received RTX (50%) Other treatments used: iv CsA, high dose steroids |
|
| Immunoadsorption | Allard et al. 2018 (25) | Children | Retrospective, multicenter | 12 | IA: median 129 sessions | 10 out of 12 (83%) | Many other treatments used: PP, iv CsA, RTX, ABT, BTZ, CP, saquinavir, galactose |
| Plasmapheresis + iv cyclosporine | Canaud et al. 2010 (89) | Children and adults | Prospective, single center | 10 | PP: 25–39 sessions CsA iv: 14 days (target level 200–400) |
10 out of 10 (100%) | All patients also received high dose oral steroids |
| Oral cyclosporine | Shishido et al. 2013 (90) | Children | Prospective, single center | 10 | CsA oral: target level 4500–5500 ngah/ml | 9 out of 10 (90%) | All patients also received high dose iv steroids |
| ACTH gel | Grafals et al. 2019 (91) | Adults | Retrospective, two centers | 14 | ACTH: 80 units twice a week | 5 out of 14 (36%) | Many other treatments used: PP, high-dose steroids, ABT, Bela, RTX ACTH used as “last resort.” In patients without PP, ACTH did not result in response Study sponsored by pharmaceutical company |
| Alhamad et al. 2019 (92) | Adults | Retrospective, two centers | 20 | ACTH: 40–80 units twice a week | 10 out of 20 (50%) | ACTH used as “last resort” if PP and RTX did not work. Divergent definition of CR and PR Researcher funded by pharmaceutical company |
PP, plasmapheresis; RTX, rituximab; CsA, cyclosporine; CP, cyclophosphamide; ABT, abatacept; iv, intravenous; BTZ, bortezomib; ACTH, adrenocorticotropic hormone; Bela, belatacept; IA, immunoadsorption; CR, complete remission; PR, partial remission.
a
CR and PR were differently defined in different studies.